BILL ANALYSIS
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Elaine K. Alquist, Chair
BILL NO: AB 710
A
AUTHOR: Yamada
B
AMENDED: June 26, 2009
HEARING DATE: July 8, 2009
7
CONSULTANT:
1
Tadeo/
0
SUBJECT
Veterans' Substance Abuse and Mental Health Services Fund
SUMMARY
Requires the California Department of Veterans Affairs to
apply to the federal Substance Abuse and Mental Health
Services Administration for funding to award grants to
community-based organizations to provide substance abuse
and mental health services to veterans.
CHANGES TO EXISTING LAW
Existing federal law:
Establishes the Veterans Health Administration, within the
U.S. Department of Veterans Affairs (VA), to provide health
care and other benefits to veterans and their families and
administer VA medical centers and outpatient clinics.
Establishes the Substance Abuse and Mental Health Services
Administration (SAMHSA), within the U. S. Department of
Health and Human Services, to improve the quality and
availability of prevention, treatment, and rehabilitative
services in order to reduce illness, death, disability, and
cost to society resulting from substance abuse and mental
illnesses.
Continued---
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Existing state law:
Establishes the California Department of Veterans Affairs
(CVA) to administer state military affairs and, among other
services, provides veterans with assistance with claims for
veterans' benefits under federal laws, provides direct
low-cost loans; and provides rehabilitative, residential,
and medical care and services at California Veterans Homes.
Establishes the Department of Mental Health (DMH), which
directs and coordinates statewide efforts for the treatment
of mental health conditions and illnesses.
Establishes the Department of Alcohol and Drug Programs
(DADP) as the single state agency authorized to receive any
federal funds payable directly to the state by SAMHSA and
serve as the lead state agency for alcohol and drug
programs. Among its charges, DADP is required to prepare a
master plan to eliminate drug and alcohol abuse in
California, and to develop and maintain a data system to
gather and obtain information on the status of alcohol and
other drug abuse problems in the State of California.
Requires counties to provide mental health services, to the
extent resources are available, to target populations
including seriously emotionally disturbed children, adults
and older adults who have a serious mental disorder,
including post-traumatic stress disorder (PTSD) and bipolar
disorder; adults or older adults who require or are at risk
of requiring acute psychiatric inpatient care, residential
treatment, or outpatient intervention because of a mental
disorder who have symptoms of psychosis, suicidality, or
violence; and persons who need brief treatment as a result
of a natural disaster or severe local emergency. Counties
must provide mental health services to veterans in need of
services who meet these existing eligibility requirements,
to the extent services are available to other adults.
Provides that if a member of the military forces of the
U.S., who served in combat, is convicted of a crime as a
result of PTSD, substance abuse, or psychological problems
stemming from service in a combat theater in the U.S.
military, who would otherwise be sentenced to county jail
or state prison, the court may order the defendant into a
local, state, federal, or private nonprofit treatment
program. The court is required to conclude that the
STAFF ANALYSIS OF ASSEMBLY BILL 710 (Yamada) Page
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defendant suffers from post-traumatic stress disorder,
substance abuse, or psychological problems as a result of
that service and the defendant must otherwise be eligible
for, and placed on, probation.
This bill:
Requires CVA to submit a grant application to SAMHSA for
the purposes of funding community based organizations,
certified by CVA, to provide substance abuse and mental
health services to veterans.
Creates the Veterans' Substance Abuse and Mental Health
Services Fund (Fund) and requires all grant money from
SAMHSA awarded to CVA, and any interest earned, to be
deposited into the Fund. Requires moneys in the Fund, upon
appropriation by the Legislature, to be used by CVA for
purposes of funding community based organizations that
provide substance abuse and mental health programs that the
Secretary of the CVA deems would benefit veterans, and to
pay reasonable administrative expenses.
Directs CVA to determine how to allocate and disburse
moneys from the Fund to community based organizations and
specifies that the moneys must only be used for providing
substance abuse and mental health services to veterans,
including, but not limited to the treatment of PTSD and
military sexual trauma.
Defines military sexual trauma to mean sexual harassment or
physical assault that is of a sexual nature, which an
individual experiences during the time he or she is in the
military.
Requires CVA to develop a process by which to certify
community based organizations that receive funding and
authorizes CVA to adopt certification standards or
conditions that may be required by SAMHSA.
Requires community based organizations that receive funding
to prepare an annual report on the programs and services
supported by the grant funds and submit it to CVA;
requires the CVA to use the report to determine renewal of
funding to a certified community based organization, based
on a criteria of success established by the CVA.
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Provides that counties in which there are no community
based organizations to serve veterans may apply for a grant
to be used by the county to fund and provide substance
abuse and mental health services to veterans.
FISCAL IMPACT
According to the Assembly Appropriations analysis of AB
710, minor absorbable costs for the grant application, and
to the extent grant funds are received on a sustained
basis, annual costs of about $100,000 for one position to
certify eligible community based organizations and
administer the grants. Presumably a portion of these costs
would be covered by the federal grant funds.
BACKGROUND AND DISCUSSION
The author states that while the VA is mandated to maintain
the capacity to provide specialized treatment and
rehabilitative services to disabled veterans, including
mental health services, not all veterans are eligible for
VA benefits. Eligibility is based on many factors,
including discharge status, length of active duty,
financial need, and a rating to evaluate the condition that
occurred or began to occur during active duty. The author
also states that VA health care services are prioritized
into seven categories, with those veterans evaluated to
have the greatest need identified as priority one.
Veterans suffering from PTSD or substance abuse receive low
priority and, consequently, report lengthy wait times for
professional care. The author further states that
veterans' mental health needs place a financial burden on
the state, and counties and organizations that serve
veterans with substance abuse and mental health problems.
The author contends that AB 710 is needed to support
community programs that serve the substance abuse and
mental health needs of veterans and to provide additional
funding for these services.
Post traumatic stress disorder (PTSD)
According to the National Institute of Mental Health
(NIMH), PTSD is an anxiety disorder that can develop after
exposure to a terrifying event or ordeal in which grave
physical harm occurred or was threatened. When in danger,
it's natural to feel afraid. This fear triggers many
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split-second changes in the body to prepare to defend
against the danger or to avoid it. This "fight-or-flight"
response is a healthy reaction meant to protect a person
from harm. But in PTSD, this reaction is erratic. People
who have PTSD may feel stressed or frightened even when
they're no longer in danger.
Traumatic events that may trigger PTSD include violent
personal assaults, natural or human-caused disasters,
accidents, or military combat. People with PTSD may
experience the ordeal in the form of flashback episodes,
and have persistent frightening thoughts and memories of
their ordeal; feel detached or emotionally numb, especially
with people they were once close to; and, be easily
startled. Feelings of intense guilt are also common. PTSD
is often accompanied by irritability, sleep problems,
depression, substance abuse, outbursts of anger or anxiety
disorders.
Symptoms usually begin within three months of the incident
but may not emerge until years later. They must last more
than a month to be considered PTSD. The course of the
illness varies. Some people recover within six months,
while others have symptoms that last much longer. In some
people, the condition becomes chronic. Effective
treatments for post-traumatic stress disorder are
available, and research is yielding new, improved therapies
that can help most people with PTSD and other anxiety
disorders lead productive, fulfilling lives.
Veterans' mental health issues
The RAND Center for Military Health Policy reports that a
substantial number of the 1.7 million military service
members returning from the conflicts in Iraq and
Afghanistan may face mental health problems. A
comprehensive study conducted by RAND in 2008 found that an
estimated 18.5 percent of those back from deployment
reported symptoms consistent with a diagnosis of PTSD or
depression. The study concluded that, the need for mental
health services for service members deployed to Afghanistan
and Iraq will increase over time, given the prevalence of
information available to date and prior experience with
Vietnam, creating additional burdens on the agencies that
will be called upon to care for them now and in the near
future.
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According to the National Center for PTSD, in addition to
other symptoms of PTSD, symptoms of combat related PTSD
include re-experiencing, continuing to think about, and
feeling as if one is still in combat; avoidance of emotion,
not wanting to discuss the event, feeling shut down
emotionally; hyperarousal, inability to relax, feeling
jumpy or always on guard, obsessive about security, and
getting angry easily. The VA also reports that PTSD may
also be accompanied by other problems such as alcohol or
substance abuse, hopelessness, shame, despair, employment
problems, relationship problems including divorce and
violence, and physical symptoms.
According to information posted on the U.S. Department of
Defense website, army soldiers are taking their own lives
in record numbers. Last year, 143 soldiers killed
themselves, a record in the past three decades since the
Army has been tallying the numbers, and nearly two dozen
confirmed or suspected suicides in January, 2009, prompted
leaders to form a senior-level task force to try to uncover
the causes and reform the systems to help suffering
soldiers. The task force found that the problem is not
simply suicide-related, but that many soldiers engage in
unhealthy and risky behavior, such as binging on alcohol
and mixing it with readily available prescription drugs.
The drugs are prescribed for combat-related injuries, but
may be used to kill the pain of returning from war to face
the realities of the home front. Failed marriages,
financial problems, military disciplinary actions, and
upcoming deployments all add to the stress. Any of these
can serve as a trigger for someone considering suicide.
Military sexual trauma
According to the VA's National Center for PTSD, military
sexual trauma refers to both sexual harassment and sexual
assault that occurs in military settings. Both men and
women can experience military sexual trauma and the
perpetrator can be of the same or opposite gender. The VA
estimates that 27 percent of men and 60 percent of women in
the armed forces have experienced military sexual trauma.
It most often occurs in a setting where the victim lives
and works. In most cases, this means that victims must
continue to live and work closely with their perpetrators,
often leading to an increased sense of feeling helpless,
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powerless, and at risk for additional victimization.
Victims are often forced to choose between continuing
military careers during which they are forced to have
frequent contact with their perpetrators or sacrificing
their career goals in order to protect themselves from
future victimization.
Among both men and women in the active duty military,
sexual trauma is associated with poor psychological
well-being, more physical problems, and lower satisfaction
with health and work. Female veterans who access VA health
care and report a history of sexual trauma while in the
military also report a range of negative outcomes,
including poorer psychological and physical health, more
readjustment problems following discharge, such as
difficulty finding work and abuse of alcohol and drugs, and
a greater incidence of unemployment due to mental health
problems. Victims of military sexual trauma also identify
PTSD as a frequent outcome. According to the 2008
Department of Defense report on military sexual trauma,
from the period of October 1, 2007, through September 30,
2008, there were 2,908 incidents of sexual trauma involving
military service members reported, of which 2,389 criminal
investigations were completed.
Access to mental health services for veterans
According to the California Association of Veteran Service
Agencies (CAVSA), California veterans number over 2.1
million, approximately 6 percent of the state's population.
California has more veterans than any other state in the
union and it is expected to continue to grow. CAVSA
reports critical obstacles exist for veterans seeking
mental health care and states that veterans are often
denied services from both VA and county providers. CAVSA
reports that:
not all veterans are eligible for VA services;
there is a decline in mental health treatment and
substance abuse treatment capacity in the VA;
a variability in services and lack of continuum of
care exists in Veterans Integrated Services Networks;
there is an increased demand from newly separated
veterans; and,
there are institutional barriers to adequate mental
health care.
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CAVSA cites the VA mental task force findings that a newly
returning veteran will find the availability of appropriate
evidence-based care is haphazard and spotty. CAVSA also
cites findings from a study published in the National
Journal of Medicine that found that, four months after
deployment, 15 to 17 percent of troops met the criteria for
PTSD, 12 months out, the same troops' rates had jumped to
21 percent.
On June 17, 2007, in a piece entitled, "The War Inside,"
the Washington Post investigated cases in which soldiers
with symptoms of PTSD were diagnosed as having a
personality disorder and given a personality disorder
discharge. Since personality disorder discharges are
considered pre-existing, personnel discharged under these
provisions cannot collect disability benefits and may not
receive medical care from the VA. Personality disorders is
a class of mental disorders characterized by rigid and
on-going patterns of thought and action.
Many other investigations have since been, and are being,
conducted as to the use of personality disorder discharges
by the military. According to "Stars and Stripes," 24,723
of these discharges were executed as of June, 2008. A
bipartisan group of U.S. Senators asked the Secretary of
Defense to launch a full review of the personality disorder
discharge process throughout the Armed Forces.
Related bills
AB 1571 (Committee on Veterans Affairs) would prohibit DMH
from approving a county's plan for the expenditure of funds
from the Mental Health Services Act, as specified, unless
it includes verifiable representation from a legitimate
veterans group in the stakeholder planning process and
includes a separate section that specifically addresses how
the mental health needs of veterans are, or are not, being
met. This bill is currently located in the Senate Health
Committee.
Prior legislation
AB 3083 (Committee on Veterans Affairs), Chapter 591,
Statutes of 2008, requires counties to provide mental
health services to California veterans in need of services
and who meet existing eligibility requirements, to the
extent services are available to other adults, and expands
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the definition of a serious mental disorder to include PTSD
and bipolar disorder for purposes of qualifying target
populations for county mental health services.
AB 2828 (Salas, 2008), which was nearly identical to this
bill, would have required CVA to apply for SAMHSA funding
to provide grants to community based organizations for
substance abuse and mental health services for veterans.
AB 2828 was vetoed by the governor, who stated in his veto
message that it was not identified as a high priority for
the state.
AB 2844 (Nation), Chapter 618, Statutes of 2006, requires
counties to provide mental health services to California
veterans in need of services and who meet existing
eligibility requirements to the extent resources are
available, and prohibits eligible veterans from being
denied county mental health services based solely on their
status as a veteran.
AB 599 (Gordon), Chapter 221, Statutes of 2005, adds
California veterans in need of mental health services who
are not eligible for care by the VA or other federal health
care provider, and who meet existing eligibility
requirements, to the existing target populations that
counties are required to serve, to the extent resources are
available.
Arguments in support
Proponents contend that AB 710 would establish a process by
which federal funds would actively be pursued and dedicated
to care for veterans.
The Regional Council of Rural Counties (RCRC) argues that
many veterans are returning home from the Iraq and
Afghanistan wars with mental health disorders and/or
substance abuse problems at a time when state and local
governments can least afford their care and that a higher
percentage of veterans live in rural areas, and the
discrepancy between rural and urban areas is growing
markedly.
The California Mental Health Directors Association (CMHDA)
states that the federal government should be doing more to
ensure veterans with mental health and substance abuse
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disorders receive timely services. CMHDA contends that, AB
710 would take advantage of available federal funding to
serve veterans and help establish a federal-state-local
community partnership to help ensure that veterans receive
the services they need in their communities, in particular,
veterans residing in small or rural communities where
service providers specializing in mental health and
substance abuse treatment are scarce.
The California Commission on the Status of Women argues
that AB 710 is needed because California has the largest
number of female veterans in the country, and they may be
at more risk for developing mental illness and more likely
to have serious psychological stress than their male
counterparts.
Arguments in opposition
CVA states that, while there is a great need for substance
abuse and mental health services for veterans, AB 710 would
require a new bureaucracy within the department and put it
in competition for grants with the very entities that the
bill seeks to help. CVA argues that it is not the
appropriate agency to apply for SAMHSA grants because DADP
is the single state agency authorized to receive SAMHSA
funds.
COMMENTS
1)Mental health services for veterans are fragmented,
limited, and for a variety of reasons, VA services may or
may not be available or accessible to veterans.
The author may wish to require that CVA, in
administrating the new grant program
proposed in AB 710, collaborate and coordinate with
DMH, county mental health
programs, federal agencies responsible for providing
veterans' services, as well as
national, state, and local nonprofit organizations that
provide veterans' services, to
maximize the integration of services and appropriate
referrals and avoid duplicating
services.
2)DADP is the single state agency authorized to receive any
federal funds payable directly to the state by SAMHSA.
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Suggested amendments:
On page 2, lines 1 - 25:
SECTION 1. Section 703 is added to the Military
and Veterans Code,
to read:
703. (a) The department shall submit a grant
application to the federal Substance Abuse and Mental
Health Services Administration (SAMHSA) consult with the
Department of Mental Health and the Department of
Alcohol and Drug Programs to identify federal funds for
the purpose s of funding community-based organizations
certified by the department, to provide substance abuse
and mental health services to veterans by June 30, 2010
and on an annual basis thereafter.
If federal Substance Abuse and Mental Health Services
Administration funds are identified, the department
shall apply for the funds through the Department of
Mental Health and/or the Department of Alcohol and Drug
Programs. If other funds are identified, the department
shall apply for the funds directly, to the extent
allowed by state and federal laws.
(b) All grant money awarded to the department by
SAMHSA, and any interest earned thereon, shall be
deposited into the Veterans' Substance Abuse and Mental
Health Services Fund, which is hereby created as a
special fund in the State Treasury. Moneys in the fund
shall, upon appropriation by the Legislature, These
funds shall be used by the department for purposes of
funding community-based organizations that provide
substance abuse and mental health programs that, in the
discretion of the secretary, would benefit California
veterans and to pay reasonable administrative expenses.
(c) (1) (A) The department shall determine how to
allocate and disburse these funds in the Veterans'
Substance Abuse and Mental Health Services Fund to
community-based organizations. The funds disbursed shall
be used only for the purposes of providing substance
abuse and mental health services to veterans, including,
but not limited to, the treatment of posttraumatic
STAFF ANALYSIS OF ASSEMBLY BILL 710 (Yamada) Page
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stress disorder, including military sexual trauma.
Page 3, lines 5 - 9:
(2) The department shall develop a certification process
by which to certify community-based organizations that
receive funding pursuant to this section. The department
is authorized to adopt certification standards or
conditions that may be required by SAMHSA. the funding
agency
PRIOR ACTIONS
Senate Veterans Affairs: 6-0
Assembly Floor: 80-0
Assembly Appropriations:16-0
Assembly Health: 18-0
Assembly Business and Professions:8-0
POSITIONS
Support: Aging Services of California
American Legion, Department of California
AMVETS - Department of California
California Association of County Veterans
Service Officers
California Commission on the Status of
Women
California Mental Health Directors
Association
California Public Defenders Association
California State Association of Counties
California Therapeutic Communities
County of San Diego
Regional Council of Rural Counties
Vietnam Veterans of America, California
State Council
Oppose: California Department of Veterans Affairs
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